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Tear-Derived Exosomal miR-15a as New Diagnostic Tool for Diabetic Retinopathy

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Published on: December 30, 2025

Population-Level Teleretinal Screening Bulk Orders to Improve Diabetic Retinopathy Screening Rates: A Randomized

Sarah W Takimoto¹, Matthew Freeby¹, Maria Han¹

¹Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.

Telemedicine Journal and E-Health : the Official Journal of the American Telemedicine Association

|June 3, 2026

Summary

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Diabetic Retinopathy

Diabetic Retinopathy

DefinitionDiabetic retinopathy is a microvascular complication of diabetes affecting the retinal blood vessels.Risk FactorsDiabetic retinopathy is present in almost all individuals with type 1 diabetes and more than 60% of those with type 2 diabetes after two decades of disease.The risk increases with poor glycemic control, hypertension, dyslipidemia, smoking, pregnancy, and puberty.Although cataracts and glaucoma are also more frequent in people with diabetes, retinopathy remains the leading...

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Teleretinal screening bulk orders significantly increased diabetic retinopathy screening completion rates in patients with type 2 diabetes. This population-level intervention improves preventative care for diabetes complications.

Area of Science:

Ophthalmology
Public Health
Endocrinology

Background:

Diabetic retinopathy (DR) is a primary cause of blindness.
Many patients with type 2 diabetes (T2DM) do not adhere to recommended DR screening schedules.
This study investigated the effectiveness of teleretinal screening bulk orders in improving DR screening rates.

Purpose of the Study:

To evaluate the impact of teleretinal screening bulk orders on DR screening completion rates among T2DM patients.
To assess the influence of electronic patient messages within bulk orders on screening adherence.

Main Methods:

A randomized controlled trial with a stepped-wedge design was employed.
Eligible T2DM patients received teleretinal screening bulk orders (retinal fundus photo order + electronic message) at staggered monthly intervals.

Keywords:

Diabetes Electronic Health Records Electronic Medical Records Public Health Telehealth

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Logistic regression and two-stage least squares analyses were used to determine the effect of bulk orders and message engagement on screening completion.

Main Results:

The overall DR screening completion rate at six months was 17.5% among 5,665 eligible patients.
Receiving a bulk order significantly increased the odds of DR screening completion (OR: 1.78; p < 0.001).
Opening the electronic patient message boosted completion rates by 8.5% (p < 0.001) and appointment scheduling by 19.1% (p < 0.001).

Conclusions:

Teleretinal screening bulk orders are an effective population-level intervention for increasing DR screening.
Implementing such interventions is crucial for enhancing preventative care in diabetes management.
Improved screening adherence can mitigate the risk of vision loss due to diabetic retinopathy.